Assessing the value of a command center model in large health care delivery systems
Reimagining health system performance through enhanced centralization and coordination
Tim Small
Laura Baker
Alison Muckle Egizi
Paige Leiser
Ipshita Sinha
Key takeaways
- Command centers enhance efficiency: By centralizing decision-making, enabling real-time data analysis, and coordinating resources across departments and agencies, command centers boost organizational response and efficiency.
- Success in private hospitals: Oregon Health and Sciences University (OHSU), Johns Hopkins Health System, and Tampa General Hospital exemplify the success of command centers in private hospital systems.
- Opportunity for federal health facilities: With foundational infrastructure, like centralized governance structure, standardized mission, and integrated service networks, already in place, federal health facilities are primed to adopt virtual command centers, enhancing robustness and efficiency.
Command centers can drive health care efficiency
In the evolving health care landscape, centralized command centers can provide a transformative solution for hospital systems. These hubs of coordination and communication offer opportunities for commercial and federal health agencies to enhance patient care by streamlining operations and working to ensure that every resource—from specialist availability to bed occupancy—can be utilized with optimal efficiency.
What are command centers
Command centers are inspired by air traffic control and mission control at NASA—and they look the part. Hospitals or systems can customize a command center according to their own needs, but typically, large screens line the walls and dashboards share real-time data across partner hospitals. Most hospitals have 20 to 30 staff members sitting on the command center floor at a given time, depending on the center’s needs.1
Command centers are the nerve center of a hospital, operating as centralized analytics hubs that monitor capacity, inventory, and patient flow. Many command centers begin with the goal of promoting patient safety and quality of care, compiling basic metrics from emergency rooms. Gradually, they can advance to tackle more complex problems like return on investments and addressing health inequities (figure 1).
Consider a recent example from Oregon Health and Sciences University. Before implementing a virtual command center, personnel used a whiteboard to manage the hospital system’s needs. At OHSU, a system comprising four hospitals, the whiteboard wasn’t keeping up with admissions. In 2016, OHSU was unable to accommodate 568 transfer patients; each was thus forced to rely on their care provider to locate an alternate facility with open beds and qualified specialists. The hospital system decided it needed to innovate. In 2017, OHSU adopted an electronic “mission control” command center. Within two years, they were referring 1,200 patients a year to partner facilities, almost double their 2017 numbers. OHSU’s new management system freed up enough beds to accept roughly 600 more transfer patients.2 The system was so successful at managing patient overflow that OHSU took over managing patients for the entire state during the COVID-19 pandemic.3
Hospital command centers—which use data analytics to track resources, patients, and special requirements—are improving the efficiency of major hospital systems. Tampa General Hospital credits its command center with saving US$40 million in the first 13 months of operation, cutting emergency-room diversions by 25%, and reducing the average length of stays by the equivalent of adding 30 beds.4
Command centers represent a natural opportunity for federal health systems, which manage vast patient volume and draw resources from wide regional networks. They can help hospitals triage efficiently, track resources, and facilitate patient transfers—saving precious provider time and lives. Some hospitals adopted command centers specifically to deal with the pandemic.5 Others adopted them earlier and have come to rely on these systems for resilience during public emergencies like hurricanes or the 2023 pediatric respiratory syncytial virus surge.6
As the US population grows and ages, climate-related health emergencies, emerging antibiotic-resistant infections, and the ongoing addiction crisis are expected to put additional pressure on hospitals.7 Command centers can help ease that burden through real-time decision-making, coordination, communication, and predictive analytics, addressing challenges beyond just patient flow management.
Methodology
This study reviewed 12 hospital systems that are currently operating command centers. Four hospitals operated within their single hospital system, with the remaining eight using command centers to coordinate care across networks of up to 11 hospitals and dozens of clinics. Several hospitals employed regional command centers at the start of the COVID-19 pandemic.
Command centers: A blueprint for breakthrough performance
Hospital command centers can make sharing and monitoring of data and resources more efficient, responsive, and informed. The cost savings and improved patient outcomes, as seen at hospital networks like Johns Hopkins Health System and OHSU, could prove equally, if not more, impactful when implemented at the scale of federal health systems. By leveraging technology and shared leading practices, government could transform public health, making high-quality care accessible and affordable. Therefore, it’s important to establish a blueprint for the operation of command centers. This blueprint should outline the types of benefits that may be reaped with the help of a command center (figure 1).
Hospitals often customize technology to suit their needs. Johns Hopkins consolidated 14 different data flow servers into one easy-to-view hub for their command center.8 Another health system partnered with fire departments and ambulance services to automate advance notice of incoming patients.9 AdventHealth managers measure the ROI of command centers through the quality of patient experience while other hospitals measure how the command center saves them money.10 A command center is a powerful tool. Simple use cases put patients in beds and providers at bedsides. More complex cases are yet to be imagined.
“You just need visibility into all the data. You need to know who’s in the bed. You need to know their expected discharge date. You need to know how many staff you have.”
—Dr. Lisa Ishii, senior vice president of operations, Johns Hopkins Health System11
Command centers in action
Tampa General Hospital
In 2018, Tampa General Hospital realized it needed a way to address its consistently high operating capacity. To improve patient flow and safety, leaders introduced a hospital command center. Modeled after existing programs at hospitals like Johns Hopkins and Humber River, the command center would be led by senior leaders in collaboration with a vendor partner, and sustained by front-line staff members like registered nurses, bed allocators, and transfer coordinators.
TGH’s command center was launched in 2019, just in time to respond to the COVID-19 pandemic.12 Overseeing a 1,000-bed level-1 trauma center, the command center integrates all aspects of the system’s electronic health records (EHR) into a central location in a standardized format, saving providers hours of time.13 Using automated visual displays, these dashboards update hospital analytics in real time to monitor information like capacity, status of patients in observation, and barriers to discharging patients.14
The results speak for themselves. The hospital cut 20,000 excess patient days, discharged patients more efficiently, and helped triage emergency room visitors.15 The US$40 million reduction in efficiencies repaid the investment within a year after implementation.16
“I’m not sure how organizations managed without a command center. It really did drive those great decisions. It gives situational awareness to the whole team.”
—Jane Casey, RN, MSN, vice president of CareComm Operations, Tampa General Hospital17
Johns Hopkins Health System
Pioneers at the Johns Hopkins Health System began planning their command center in 2014, as an extension of existing work groups focused on patient flow.18 The team included transfer line staff, admissions support, lifeline support, and bed managers, all of whom report to a medical director.
The system informs decisions. For example, if multiple stroke patients need one MRI machine, a physician can quickly compare each patient and sort them by level of deterioration. If a patient has multiple tests to run, the hospital can try to consolidate them into one trip, instead of returning to the bed each time. Hopkins also uses their command center to predict future patient volumes.19
The commitment to enhance patient experience is a crucial aspect of the command center’s functionality. At Hopkins, the command center personnel dedicate a specific screen to maintain a live feed from the waiting room.20 This practice serves as a constant reminder of the individuals they are ultimately serving and underscores the importance of patient-centered care.
Johns Hopkins’ results include:
- Enhanced proactive capacity management, boosting occupancy rates from 85% to 92%, despite a decrease in patient delays21
- A 46% improvement in accepting patients with complex medical conditions22
- A 38% reduction in time to assign beds, accelerating the process by 3.5 hours after the decision to admit23
- An 83% reduction in operating room transfer delays after the procedure24
- Generated US$16 million in annual revenue25
The transition was incremental, and setting up the command center took some time.26 But the results improved patient care and increased revenue for the health system, providing resources to further improve the patient experience.
Regional command center partnerships in play
To enhance health care service delivery, private hospital systems are increasingly leveraging regional partnerships to effectively manage resources, staffing, and bed capacity. This approach not only streamlines operations but also improves patient outcomes by ensuring that hospitals are well-equipped and adequately staffed to handle varying levels of patient care needs. Below are examples of how this strategy is being implemented in practice.
- OHSU, General Electric HealthCare, and Apprise (the Hospital Association of Oregon) implemented a statewide capacity-monitoring system during the COVID-19 pandemic.27 This program, using a dashboard that monitored bed availability and ventilator resources, allowed for rapid surveillance of the state’s 62 hospitals.28 The system worked. According to the Commonwealth Fund’s data set tracking days of high intensive care unit (ICU) stress across the United States during the pandemic, Oregon’s ICUs were overwhelmed for only 16 days between August 2020 and March 2022.29 In contrast, a third of states experienced between 150 and 566 days of overstressed units.30
- Tampa General Hospital helped set up a near-real-time Florida Capacity System across 51 hospitals in West Florida to manage beds, equipment, and hospital census numbers using command center tools.31
- The Halifax Infirmary site was the start of Nova Scotia’s “Action for Health.” This strategic initiative aims to increase efficiency of care delivery and experiences across Nova Scotia.32 As part of this action plan, they launched a command center named as Care Coordination Centre. It aims to increase efficiency, improve communication between clinics and higher care, and proactively improve health in the community, and eventually expand provincewide.33
Developing common command center capabilities
Common themes emerged from our interviews on how to create, implement, and sustain a digital command center. Figure 2 shows how a regional command center advances from basic to intricate tasks, through progressive levels of complexity, and expanding scope and scale. Such a virtual health support network enhances accessibility, convenience, and the overall experience of health care delivery and reception. When their potential becomes clear, hospitals can expand command centers to manage tasks like ICU prioritization, surgical scheduling, and infectious disease monitoring.
Lessons learned from the field
Getting the system up and running
Start small. A fully developed system doesn’t have to pop up overnight. Accomplishing early wins through efficiency and improved safety can serve as a proof of concept and identify points of friction. Then the team can expand their ambitions.
Federal health leaders may struggle to maintain oversight of their large network of operations. A centralized view—and data clearinghouse—could potentially improve their emergency response efforts, along with allocation of vast resources.
“If you try to rush it, I don’t think the culture shift required for the (command center) will be successful. It needs time. You need to have some successes with the flow of patients. Then you can move to quality. The sky’s limit after that.”
—Jane Casey, RN, MSN, vice president of CareComm Operations, Tampa General Hospital34
Define the mission. Just as existing regional operations took years to develop, large-scale, operational command centers are not created overnight. These efforts often require ongoing maintenance as users tailor them to the region’s needs. Defining the mission of a command center—capacity improvements, patient safety, and quality of care—is a first step to collecting insights and data that inform the mission.
Incorporate health equity. Command centers can be used for more than just patient load management. They can help track community resources and identify patterns in vulnerable communities. Correlations between societal factors and health outcomes could reveal targeted approaches. The lessons from targeted interventions could improve not just hospital efficiency, but also the science of health care itself.
Physician, front-line team, and administrative leaders need a hand in the process. Securing support from front-line staff is crucial for implementing hospital command centers. “It’s a huge culture change,” said Jane Casey, RN, MSN, vice president of CareComm Operations, Tampa General Hospital. “It takes patience and time to make it happen.”35
Generating buy-in and building momentum
Buy-in has to be earned. “You have to prove it in the numbers,” said Dr. Sanjay Pattani, associate chief medical officer for AdventHealth. “It didn’t make sense for one hospital to be operating at 110% of capacity while our sister hospital four miles down the road was at 78%.”36 AdventHealth earned trust in part by showing care providers how technology could help their patients. In the case of the Geisinger health system, reliance on technology helped them monitor and significantly reduce their opioid prescriptions. Until the data was staring at them, their physicians were unaware of their prescription patterns.37
“People, process, trust, and governance are big here,” says Dr. Lisa Ishii of the Johns Hopkins Health System. Anyone who has invested in becoming skilled at their job may hold suspicion toward changes to the processes they’ve mastered. Especially after experiencing the frustrating rollout of EHRs, it may take time for physicians to fully embrace a new digital management tool. That’s one reason to consider for including stakeholders in the process from the start.
Develop operations and governance models with stakeholders. A command center is essentially an operational tool, and thus, it may make sense to develop those operations in conjunction with the people who will use them. By integrating operations into existing clinical workflows, an organization can achieve greater adoption without overburdening the end users.
Clear governance keeps the data consistent, routines familiar between hospitals, and help clarify accountability. Johns Hopkins found that previously staff were inconsistent when it came to explaining delays.38 “Surgeon stuck in operation,” “transport hasn’t arrived,” and “patient uncooperative” all require different responses from management. Issues are more difficult to solve without real-time visibility and it’s often hard to prevent them without a record of their frequency. Leaders had to educate staff on why accurate delay codes mattered—and train them so each individual would enter the same code in the same situation.
Appoint physicians on duty. To help ease the transition, some hospitals used a “physicians on duty” approach. Physicians on duty are highly trained senior staff members that help direct command center operations alongside hospital leadership. Each day, one physician on duty manages operations from mission control. CHI-Franciscan selected a pool of physicians on duty with at least 10 years of experience and a high level of trust with staff. Split evenly between emergency room physicians and hospitalists with a sprinkling of surgeons, these leaders spent months learning the systems and developing a standard workflow.39 With a stake in the process, and familiarity with its purpose, they could explain the system to colleagues.
“It’s got all your information right at your fingertips. Different views are used daily by command center staff, executives, and the front-line team.”
—Jane Casey, registered nurse, masters of science in nursing, vice president of CareComm Operations, Tampa General Hospital40
Timely and accurate data is an important success factor. A data monitoring system relies on accurate data. Accurate data depends on the collaborative efforts of all stakeholders. It’s not enough to track admissions at one hospital; partner hospitals need to track available capacity as well. Care providers on the hospital floor should understand the importance of updating the system amid patients vying for their attention. Hospitals hoping to share resources will likely need a consistent method for tracking inventory and equipment maintenance logs. Collaboration requires making sure people understand their responsibilities.
Lock in the benefits
Keep data—and methods to record it—standardized. For different hospitals to share information in a meaningful way, the data must be comparable. Vital signs are useful to care providers in part because they are standardized. A chart tells an admitting emergency room physician a clear story about a patient because providers take vitals in a consistent way. Even when describing signs that could be subjective, like pupil dilation or mental status, providers use a standardized notation. Likewise, the metrics of hospital resources should have common nomenclature and record-keeping.
Technology should standardize across hospitals that have implemented different incompatible software.
Federal health facilities may have an advantage over private hospital systems. Hospitals within the Military Health System (MHS) already operate under MHS Genesis, a centralized EHR. However, hospitals still need standardized definitions and data classifications. The computers need to communicate, and the providers need to respond using consistent input methods for comparable scenarios.
“You would be shocked how much noise gets created when people are entering data in nonstandard ways. And then you can’t understand what the holdup is.”
—Dr. Lisa Ishii, senior vice president of operations, Johns Hopkins Health System41
Change often causes discomfort. Command centers represent a change in hospital operations, and that can result in resistance. Command centers “shine a light in all of the dark places of operations,” said Dr. Pattani. “That transparency made people more aware and accountable.”42 It could also be uncomfortable. Standard methods of record-keeping make it harder to massage statistics. Administrators of different institutions must face their shortcomings, or worse, reveal them to their neighbors. These discoveries at least expose opportunities for improvement. “Such valuable data came out of this,” said Jane Casey, RN, MSN, vice president of CareComm Operations, Tampa General Hospital. “Some of it was on the level of, ‘Wow, that’s happening?’ It was really revelatory.”43
Some hospitals can get pushback when changes affect their individual workstreams. Operationalizing the whole hospital system would mean some administrators might feel a loss of control over details that were once solely their domain.
Private hospitals can also face concerns about anti-collusion laws and Health Insurance Portability and Accountability Act; both can be resolved by consulting with legal counsel and information technology specialists. The bigger challenge is convincing executives to share data. The fear of sharing sensitive data is not unique to the health care industry. Data-sharing systems in shipping ports and other industries faced similar challenges with participants worried about revealing proprietary information to competitors. But successful solutions are possible. The Port of Hamburg was able to create a port-scheduling system with data shared from competing shipping companies, and in Germany an automotive industrywide tool for data-exchange was implemented to coordinate supply chains.44 In both cases, acknowledging these concerns was an important first step. From there, privacy-respecting architectures could be created to ingest proprietary information to be shared only in aggregate or with trusted moderators.
Patients, too, may resist change. If a partner hospital has open beds but represents an extra hour drive for their family, or takes the wrong insurance, patients may prefer to wait for care at a flagship hospital that is overcapacity.
A case for federal health system command centers
Federal health facilities such as the Veterans Health Administration (VHA) and the Military Health System appear well positioned to adopt virtual command centers. Both agencies already share resources across integrated and technologically enabled regional frameworks and have varied service delivery types.45 The VHA has more than 20 integrated services networks and more than 1,200 health care facilities, including 170 Department of Veterans Affairs medical centers and 1,074 outpatient sites that serve over 9 million enrolled veterans each year.46
The MHS comprises approximately 470 military hospitals and clinics worldwide and serves over 9.5 million beneficiaries, including active-duty service members, retirees, and their families.47 Their shared EHR platform, MHS Genesis, follows active-duty military personnel across military and civilian care.
These agencies already have design elements that align to critical success factors in commercial command centers. These include but are not limited to:
- Standardized systemwide mission, consistent across all facilities and regions, centered on the principles of access, quality, efficiency, and readiness
- Centralized governance structure
- Standardized electronic health records
- Standardized patient and provider workflow
- Standardized data governance and IT platforms
- Shared resources and consistent delivery methods
- Standardized provider incentive structure
Given these foundational strengths, these federal agencies can customize their regional command centers depending on their needs and strategy. Each regional command center could be configured to encompass a broad geographic area, potentially spanning multiple states or territories, to provide inclusive and uniform coverage across facilities. These centers would encourage resource-sharing between various federal, state, and local health systems, thereby enhancing their ability to meet health care demands and emergencies. Federal health operations could potentially facilitate systemwide clinical load distribution, proactive resource management, and preparedness for potential specialist care requirements by:
- Coordinating bed management with community and federal or state emergency management agencies for disaster responses, public health emergencies, and casualty distribution situations
- Monitoring contact center data to identify surges in demand for acute or ambulatory care and dynamically manage virtual care capacity
- Utilizing advanced algorithms and real-time data analytics to optimize the allocation of medical personnel, equipment, and facilities, ensuring that resources are efficiently utilized and are responsive to changing health care demands
- Establishing a network of specialty care hubs within the command center’s region to manage high-complexity cases more effectively. This network would facilitate rapid referral and consultation processes, ensuring patients have access to specialized care when needed.
- Developing and expanding digital health platforms to include remote patient monitoring and mobile health applications, which can provide continuous care and monitoring outside of traditional health care settings, particularly beneficial during periods of high demand
- Improving interoperability between different health information systems within federal and state agencies to ensure seamless data exchange and communication. This will support more coordinated care delivery and efficient emergency response.
As health systems whose core mission is to provide the highest quality of care to those they serve, federal health facilities and their patients stand to benefit from command centers.
“I’m not sure how we functioned prior to the development of a command center. I mean, I know how we did, because it was extremely painful. But that was accepted as just general operations.”
—Dr. Sanjay Pattani, associate chief medical officer, AdventHealth48
The promise of better care could be possible through tightly coordinated and timely operational actions
Hospital command centers offer to collect and share data in real time. What hospitals do with that data can dramatically improve patient experience, save money, and reduce wait times. Its simplest manifestation—an air traffic control for patients across a regional network of care—can address federal hospital networks’ most important needs and play to their existing advantages.
“A lot of people, especially in health care, are extremely scared of change. I think we created a feeling of optimism. That’s something I look back at. I just smile every time I look at where we are now versus where we were.”
—Dr. Sanjay Pattani, associate chief medical officer, AdventHealth49
Ultimately, command centers help hospital systems improve performance. They are designed to facilitate teamwork, enable innovation, and can even be used to reduce health inequities across a region. Federal health systems can utilize these tools to great effect, leveraging existing regional networks to test the approach in a region with the greatest promise, starting with one small piece of available health data.
Federal agencies like the MHS and the VHA seem already well positioned. These agencies have robust infrastructures and extensive experience managing complex health networks. The maturity model framework is aimed to support federal agencies in maximizing the potential of establishing command centers.
The potential is considerable, and the steps to realize it are achievable. If federal health leaders were to adopt a regional command center model, decreased patient wait times alone may justify the effort. From there, as with any tool, it’s a process of exploring the possible. The implementation process is iterative and involves continuous learning and adaptation. This evolution promises improved performance and a more equitable and responsive health care system.